Parkinson's disease: clinical manifestations and treatment

Abstract

This review describes and synthesizes the clinical manifestations, differential diagnosis, and treatment of Parkinson's disease (PD). PD is a common neurodegenerative disorder affecting approximately 0.5 to 1% of the population over the age of 65.The cardinal features of PD include tremor, bradykinesia, rigidity and postural instability.There are also a number of secondary features that are important to recognize and treat, including cognitive dysfunction, depression, anxiety, autonomic dysfunction, and disturbances of sleep. Only approximately 75± 80% of patients that present with parkinsonian features have idiopathic PD. Other disease entities that can present with parkinsonism are reviewed. It is important to recognize these disorders since treatment and prognosis for the parkinsonian syndromes are markedly different from idiopathic PD. In addition, current medical and surgical approaches for the treatment of PD are reviewed.The mainstay of treatment for PD remains levodopa, but there are a number of supplementary medications including anticholinergics and dopamine agonists, which are useful in the treatment of PD. Surgical approaches including thalamotomy, pallidotomy and deep brain stimulation are receiving increased attention as adjunctive therapy for treatment of PD.

Lived Experiences of Adult Children Who Have a Parent Diagnosed with Parkinsons Disease

“…There is no biological marker that confirms its diagnosis. The diagnosis of PD is made based on the presence of the classic triad of major motor signs: tremors, rigidity or muscle stiffness, and postural instability or imbalance (Dawson, 2000). It is a disease that has no age, race, sex, or socioeconomic boundaries.…”

Etiologic and Phenotypic Similarities between Medication-Induced Syndromes and Courts' Customary Interpretation of Mental Disease in Exculpatory Defenses

“…Parkinsonism directly results from decreased levels of dopamine in the brain as a result of cell destruction in the substantia nigra (Dawson, 2000). Dopamine is a major neurotransmitter (catecholamine) responsible for muscle and movement control, cognitive functioning (e.g., memory processing, attention, and concentration), behavioral activation/autonomic response, stress response, neuropsychological reward mechanisms (e.g., sexual activity and eating), and goal-directed behavior.…”